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頁籤選單縮合
題名 | Enterovesical Fistula: Experiences with 41 Cases in 12 Years=腸道膀胱瘻管:12年41例的經驗 |
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作者 | 劉兆漢; 莊正鏗; 朱聖賢; 陳孝文; 陳志碩; 江仰仁; 周建中; | 書刊名 | 長庚醫學 |
卷期 | 22:4 1999.12[民88.12] |
頁次 | 頁598-603 |
分類號 | 416.27 |
關鍵詞 | 腸道膀胱瘻管; 惡性腫瘤; 憩室炎; 尿路感染; Enterovesical fistula; Malignancy; Diverticulitis; Urinary tract infection; |
語文 | 英文(English) |
中文摘要 | 背景:腸道膀胱□管在臨床上屬於不多見且易被延誤診斷的一種疾病。不僅無單 一檢查工具能確立診斷,治療上也因病患的嚴重程度不同而有不同的處理方法。本回顧性的 研究是報導本院的經驗。 方法:從l984到1996年閒,有41位腸道膀胱廔管患者在本院住院治療。我們回顧他們的病 歷資料及X光的檢查。 結果:有38位(92.7%)病例是與惡性腫瘤有關。在這38位病患中,有15位(39.5%)是因腫瘤 侵私而引起腸道膀胱□管。臨床表現上最多的是尿液中可見糞便物質(58.5%)。而診斷工具 中,膀胱鏡檢查,大腸攝彰,皆有一定的確定診斷率。腹部電腦斷層則對腫瘤侵犯程度提供 一良好的參考。在治療的選擇上有尿路分流、腸道分流、單一階段修補術或多階段修補術。 結論:在本院腸道膀胱□管似多因潛在惡性腫瘤引起,這與國外文獻報告多由大腸憩室炎造 成有所不同。這可能與東方人的憩室炎低發生率有關。如要確定診斷腸道膀胱□管較可靠的 診斷工具依序是膀胱鏡檢查,大腸造影,膀胱造影及腹部電腦斷層。在治療上,原則是依病 情不同而有不同的處理方式,控制惑染是最先要做的,若病患病情圖重可考慮腸道或尿路分 流,而對於身體情況尚可的病患,單一階段修補術是安全的選擇。 |
英文摘要 | Background: A retrospective analysis of enterovesical fistula treated at Chang Gung Memorial Hospital was conducted to determine the optimal diagnosis and management of this disease. Methods: The records of 41 patients who presented from 1984 to 1996 and had a final diagnosis of enterovesical fistula were retrospectively reviewed. The etiology, symptoms on presentation, diagnostic tools, and modality of treatment were analyzed. Results: The majority of these cases were associated with malignancy (38, 92.7%), and the others with diverticulitis (2, 4.9%) and latrogenic causes (1, 2.4%). In those with malignancy, 15 patients (39.5%) were found to have tumor recurrence. The most frequent symptom in enterovesical fistula was fecaluria (58.5%), followed by abdominal pain (22%) and dysuria (14.6%). Diagnostic tools included the barium enema, cystography, and cystoscopy these methods could identify the fistula in 63.2%, 60%, and 53.8% of the patients, respectively. Methods of management included diversion only (39%), one-stage fistula repair (36.6%), and watchful surveillance (24.4%). Conclusion: Enterovesical fistula should be considered if fecaluria, pneumaturia, or persistent non-specific urinary tract infection present as the initial complaint. A thorough survey for a possible underlying malignancy is mandatory when confronted with enterovesical fistula, since the incidence of inflammatory bowel disease is low in this area. An abdominal computer tomography (CT) scan, barium enema, and cystogram can be useful diagnostic tools. Treatment of this entity should be individualized according to each patients clinical status. |
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